| NPI | 1205289022 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MI 5302041826) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: AZ S022883) |
| 183500000X Pharmacist (Licence: TN 38529) | |
| Enumeration Date | 2016-07-16 |
| Last Update Date | 2018-05-01 |